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Children with diabetes benefit from exercise
  1. J I Wolfsdorf
  1. Correspondence to:
    Dr J I Wolfsdorf
    Division of Endocrinology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA;

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Commentary on the paper by Massin et al (see page 1223)

How much physical activity do children require to obtain beneficial health and behavioural effects? The recent report concerning the effects of regular physical activity on health and behavioural outcomes in 6–18 year old youth recommends that school age youth should participate daily in at least 60 minutes of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities.1 There is strong evidence for beneficial effects of physical activity on: musculoskeletal and cardiovascular health, adiposity in overweight youth, and blood pressure in mildly hypertensive adolescents. Physical activity also has a beneficial effect on anxiety, depression, and self-concept. The 60 minutes or more of physical activity can be achieved in a cumulative manner in school during physical education, recess, intramural sports, and before and after school programmes.

Exercise requires considerable alterations in fuel metabolism and presents unique challenges for the person with type 1 diabetes mellitus (T1D).2 During the first 5–10 minutes of moderate intensity exercise, skeletal muscle glycogen is the major fuel for working muscle. With increasing duration of exercise, plasma glucose and non-esterified fatty acids (NEFA) predominate, and to meet the increased demand for fuel, a complex hormonal and autonomic response increases hepatic glucose production and mobilisation of NEFA from adipose tissue. Plasma insulin concentration decreases and levels of the counter-regulatory hormones (adrenaline, noradrenaline, glucagon, cortisol, and growth hormone) increase, resulting in enhanced hepatic production of …

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  • Competing interests: none declared

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